^(68)Ga-FAPI和^(18)F-FDG PET/CT在初诊及复发转移性胃印戒细胞癌中的应用比较  

Comparison of ^(68)Ga-FAPI and ^(18)F-FDG PET/CT for the diagnosis of primary and metastatic gastric signet-ring cell carcinoma

作　　者：赵龙[1] 逄一臻 徐伟植 孟庭华 蔡佳宇 彭添兴[1] 罗作明[1] 孙龙[1] 吴华[1] 陈皓鋆[1] Zhao Long;Pang Yizhen;Xu Weizhi;Meng Tinghua;Cai Jiayu;Peng Tianxing;Luo Zuoming;Sun Long;Wu Hua;Chen Haojun(Minnan PET Center,the First Affiliated Hospital of Xiamen University,Xiamen 361003,China)

机构地区：[1]厦门大学附属第一医院核医学科及闽南PET中心,厦门361003

出　　处：《中华核医学与分子影像杂志》2023年第6期325-330,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(82071961)。

摘　　要：目的探索^(68)Ga标记成纤维细胞激活蛋白抑制剂(FAPI)PET/CT显像在初诊及复发转移性胃印戒细胞癌(GSRCC)中的诊断效能,并与^(18)F-FDG PET/CT进行比较。方法回顾性分析2020年6月至2022年5月在厦门大学附属第一医院闽南PET中心行^(18)F-FDG和^(68)Ga-FAPI PET/CT显像的初诊及复发转移性GSRCC患者21例,其中男10例、女11例,平均年龄52岁。以手术和(或)穿刺病理结果作为最终诊断的"金标准";对未能接受手术或穿刺病理证实的可疑病灶,以实验室检查、临床及影像随访结果作为最终诊断的参考标准。分析患者2种PET/CT图像,采用Wilcoxon符号秩检验比较^(18)F-FDG和^(68)Ga-FAPI的SUV max。采用McNemarχ^(2)检验比较^(18)F-FDG和^(68)Ga-FAPI PET/CT对GSRCC病灶检出率的差异。结果^(68)Ga-FAPI在原发肿瘤[5.3(2.4,15.7)与2.4(1.8,2.5);z=2.31,P=0.021]、局部复发灶[7.8(6.0,8.9)与2.4(1.9,3.4);z=2.20,P=0.028]、淋巴结转移灶[7.7(4.5,12.2)与2.4(1.9,3.6);z=6.01,P<0.001]及骨骼和(或)内脏转移灶[6.7(5.3,11.1)与2.4(2.0,3.4);z=11.36,P<0.001]中的SUV max明显高于^(18)F-FDG。在诊断效能方面,^(68)Ga-FAPI PET/CT对GSRCC原发肿瘤(7/9与2/9;χ^(2)=3.20,P=0.063)和局部复发灶(7/7与2/7;χ^(2)=3.20,P=0.063)的诊断灵敏度有高于^(18)F-FDG PET/CT的趋势;对可疑淋巴结转移灶[86%(65/76)与32%(24/76);χ^(2)=31.37,P<0.001]、骨骼和(或)内脏转移灶的检出率明显高于^(18)F-FDG PET/CT[99%(184/185)与39%(73/185);χ^(2)=107.08,P<0.001]。结论^(68)Ga-FAPI PET/CT在初诊及复发转移性GSRCC中显示出了较^(18)F-FDG更高的显像剂摄取及病灶检出率。^(68)Ga-FAPI PET/CT在GSRCC的诊断、分期及复发监测中具有较高的诊断效能,有助于进一步指导临床治疗决策。Objective To investigate the clinical utility of ^(68)Ga-labeled fibroblast activation protein inhibitor(FAPI)PET/CT in the detection of primary and metastatic gastric signet-ring cell carcinoma(GSRCC)and compared the results with those of ^(18)F-FDG PET/CT.Methods A total of 21 patients(10 males,11 females,average age 52 years)with primary and metastatic GSRCC who underwent ^(68)Ga-FAPI and ^(18)F-FDG PET/CT at the First Affiliated Hospital of Xiamen University from June 2020 to May 2022 were retrospectively analyzed.Pathological results of surgery and(or)biopsy were used as the"gold standard"for final diagnosis.In cases whose surgery or tissue biopsies were not available,clinical and radiographic follow-up results were used as the reference standards.Wilcoxon signed-rank test was used to compare the SUVmax of ^(18)F-FDG and ^(68)Ga-FAPI.McNemarχ^(2) test was used to compare the detection rate between ^(18)F-FDG and ^(68)Ga-FAPI PET/CT.Results ^(68)Ga-FAPI PET/CT showed higher SUVmax than ^(18)F-FDG in primary tumors(5.3(2.4,15.7)vs 2.4(1.8,2.5);z=2.31,P=0.021),local recurrences(7.8(6.0,8.9)vs 2.4(1.9,3.4);z=2.20,P=0.028),lymph nodes metastases(7.7(4.5,12.2)vs 2.4(1.9,3.6);z=6.01,P<0.001)and bone/visceral metastases(6.7(5.3,11.1)vs 2.4(2.0,3.4);z=11.36,P<0.001).Regarding diagnostic accuracy,^(68)Ga-FAPI PET/CT showed higher sensitivities than ^(18)F-FDG for primary tumors(7/9 vs 2/9;χ^(2)=3.20,P=0.063)and local recurrences(7/7 vs 2/7;χ^(2)=3.20,P=0.063).It also demonstrated higher lesion detection rates than ^(18)F-FDG for suspicious lymph node metastases(86%(65/76)vs 32%(24/76);χ^(2)=31.37,P<0.001)and bone/visceral metastases(99%(184/185)vs 39%(73/185);χ^(2)=107.08,P<0.001).Conclusions ^(68)Ga-FAPI PET/CT showed higher tumor uptake and lesion detection rate than ^(18)F-FDG in the primary and metastatic GSRCC.^(68)Ga-FAPI PET/CT demonstrates good diagnostic performance for tumor detection,staging,and restaging of GSRCC,which is helpful to further guide clinical treatment strategy.

关 键 词：癌 印戒细胞 胃 喹啉类 氟脱氧葡萄糖F18 正电子发射断层显像术 体层摄影术 X线计算机 

分 类 号：R735.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]